Individual
KENNETH P PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15910 VENTURA BLVD, SUITE 1502, ENCINO, CA 91436-2802
(818) 728-9877
Mailing address
15910 VENTURA BLVD, SUITE 1502, ENCINO, CA 91436-2802
(818) 728-9877
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
C50553
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G50553
STATE LICENSE NUMBER
CA
Enumeration date
04/27/2006
Last updated
04/01/2014
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